There are many holy grails in medicine with failure after failure – like finding a way to prevent Alzheimer’s disease . But one of the most biggest and most daunting has been finding drugs that tackle obesity. Ozempic has already been approved in January 2020 for improving glucose regulation in diabetes.
The next drug to be imminently approved is tirzepatide following its approval for diabetes in May 2020. It is noteworthy that the discovery of these drugs for weight loss was serendipitous. They unexpectedly found to achieve significant weight reduction. Both semaglutide (ozempic) and tirzepatide underwent randomized controlled trials in obesity. Tirzepatide at a dose of 10 to 15 mg a week achieved >20 %body weight reduction and semaglutide at a dose of 2.4 mg achieved 17% reduction.
Note : these levels of body fat percentage resemble what is typically achieved with the various types of bariatric surgery such as gastric bypass.
The results with semaglutide were extended to teens in a randomized controlled trial and a similar trial with tirzepatide is in progress.
Their effects include enhancing satiety, delayed gastric emptying, increasing insulin and its sensitivity,decreasing glucagon and reducing high glucose levels.
common side effects include nausea, vomiting, constipation, diarrhoea, however despite this the drug was rarely discontinued. Both drugs achieved favorable effects on lipids – with a reduction in triglycerides and LDL and raising HDL. Other rare side effects have been noted which include gallstones,and medullary thyroid carcinoma (so far documented in rats ),so contraindicated in Multiple endocrine neoplasia . To reduce the side effects semaglutide is given in escalating doses starting at 0.25mg for a month with gradual increase to 2.5mg .
For semaglutide the indication is a BMI of 30 or greater than 27. Durable changes in lifestyle must accompany these drugs as without them weight is likely to be regained after stopping them.
This may signify the end or a marked reduction in bariatric surgery.
